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Doctors urge more research into little-known STIs linked to infertility in men and women

Doctors are urging more research into a little-known sexually transmitted infection that may be more common than believed.

Scientists have known for decades about Mycoplasma genitalium, or M. genitalium or M. gen., a sexually transmitted infection that can cause genital pain, bleeding, and swelling, and has been linked to infertility and miscarriage. . However, it wasn’t until 2019 that the first Food and Drug Administration-approved test for M. gen. became commercially available. Many cases may go undiagnosed and untreated, doctors warn.

“It’s a real concern,” said Dr. Irene Stafford, associate professor of maternal-fetal medicine at McGovern Medical School at UTHealth Houston. “Why don’t we look into this?”

Stafford called for more research and testing of the bacterial infection on Tuesday at the Centers for Disease Control and Prevention conference for the prevention of sexually transmitted diseases, where CDC officials warned of an increase “out of control” of STDs.

Similar to chlamydia and gonorrhea, M. gen. is sometimes asymptomatic, but can lead to serious complications in both men and women. In men, it can cause urethritis, swelling and irritation of the urethra. In women, M. gen. is associated with cervical swelling, pelvic inflammatory disease, miscarriage, premature labor and infertility. In May, a large study published in the journal Sexually Transmitted Infection found that the risk of preterm birth was nearly doubled in women with M. gen.

However, more research is needed to determine the long-term risks of M. gen infection, the experts said.

What are the symptoms ?

Because the tests are relatively new, doctors don’t have to report diagnosed cases, and the CDC doesn’t recommend routine screening, it’s unclear what the prevalence of STIs is or who is most at risk. A patient is usually only screened if symptoms persist after testing negative for other STIs.

“We learn more about the epidemiology of sexually transmitted infections when we have better testing methods,” said Erik Munson, assistant professor of medical laboratory sciences at Marquette University in Milwaukee.

Symptoms can include:

  • Pain and discomfort when urinating.
  • Abnormal discharge for men and women.
  • Women may also experience pain in the lower abdomen and bleeding after sex.

Up to 20% of sexually active women and 16.5% of men aged 15 to 24 could be infected with M. gen., according to Lisa Manhart, professor of epidemiology at the University’s School of Public Health. from Washington.

By comparison, chlamydia, the most commonly reported STI in the United States, ranges from 4% to 7% among sexually active young women, depending on location and risk factors.

Given its association with pregnancy complications, Stafford believes that high-risk pregnant women should be screened for M. gen. But screening programs can be expensive, especially without more risk research available to justify the costs.

“We have very good studies showing that if we screen for and treat chlamydia and gonorrhea, we can actually prevent infertility and PID. [pelvic inflammatory disease]Manhart said “We don’t have that kind of evidence for M. genitalium.”

Superbug worries

The calls for more research are urgent — the bug has developed resistance to the antibiotic most commonly used to treat STIs, azithromycin or “Z-Pack,” according to the CDC.

Another antibiotic, moxifloxacin, is effective but can cause serious side effects, making it an especially risky choice for pregnant women. Additionally, the greater the exposure to moxifloxacin M. gen. a, the more likely it is to become resistant to that antibiotic as well, experts warn. Beyond moxifloxacin, there are very few treatments for the infection.

“M. genitalium quickly developed resistance to all the antibiotics used to treat it,” Manhart said. “We already have incurable infections.”

Although these cases are rare, some fear that M. gen could become a completely resistant superbug. Until scientists find new treatments for the STI, public health experts approach its treatment with caution.

For now, the CDC says the best strategy for treating M. gen is to test for antibiotic resistance before deciding which drugs to use. However, these tests are not approved by the FDA.

“The CDC is putting a large inventory into stress testing, and right now it’s not readily available,” Munson said.

Only a few specialized research centers can test whether the infection is resistant to an antibiotic. While the companies are working on widely available versions they could be years away from, as well as new or repurposed antibiotics effective against the stubborn bug, Munson said.

Experts hope that greater public awareness of STI could provide a much-needed boost to research efforts.

“Because the implications of untreated Mr. gen. on fertility and sexual health is real,” Stafford said.

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